USRDS 2017 report finds high cost, high burden, low awareness of kidney disease in US

By ASN Staff

The recent annual report released by the United States Renal Data System (USRDS) found the following highlights:

Children with Kidney Failure

Fewer children under five years old with kidney failure are dying. Mortality one year after kidney failure has dropped by nearly half over the past decade.

Kidney Transplant Waiting List

For the first time ever, the number of people waiting for a kidney decreased. This may be related to a recent change in federal policy on kidney transplantation.

Mortality

Dialysis patient mortality decreased by nearly one-third from 2001 – 2015, but mortality rates have stabilized in recent years.

Chronic Kidney Disease (CKD)

1 in 7 Americans has chronic kidney disease, but most of them are not aware of their disease.

Acute Kidney Injury

Only 1 out of every 7 Medicare patients hospitalized for acute kidney injury saw a kidney doctor after discharge. More than 1 in 3 were re-hospitalized.

Kidney Failure

The United States has the third highest rate of new cases of kidney failure in the world. The rate of new cases in 2015 was similar to recent years.

Vascular Access

4 out of 5 new dialysis patients start was a catheter, which can lead to preventable infections. Fewer than 1 in 5 starts with the preferred access type: an arteriovenous fistula.

Cost to Medicare

In 2015, 1 out of every 5 Medicare dollars was for patients with CKD. Medicare spend $98 billion for people with chronic kidney disease, including $34 billion for people on dialysis.

Additional important findings:

The one-year end-stage renal disease patient mortality among the 0-4-year age group has declined approximately 41.6 percent over the past decade. This is good news.

The kidney allocation system policy changes resulted in a first time decrease in kidney transplant waiting list by 2.3 percent. While too soon to predict longer term benefits, the new policy may assist minorities and low-income persons, who often take longer to get waitlisted.

Incidence rates of end-stage renal disease have stabilized in the U.S., however there are large variations around the country with many hotspots.

Eighty percent of patients still use catheters as the main vascular access at initiation of hemodialysis. This must change, as catheters predispose to serious infections and higher mortality.

Seventeen percent of patients used an arteriovenous fistula exclusively at dialysis initiation. This increased to 65 percent by the end of one year on hemodialysis, and to 72 percent at the end of two years.

Between 2001 and 2015, adjusted mortality rates decreased by 28 percent for dialysis patients. The net reductions in mortality from 2001 to 2015 were 27 percent for hemodialysis patients and 41 percent for peritoneal dialysis patients. However, since there appears to be a stabilization in mortality rates in recent years, there is no room for complacency.

In 2013, Medicare patients aged 66 years and older who were hospitalized for an acute kidney injury (AKI) had a 35 percent cumulative probability of a recurrent AKI hospitalization within one year.

The recent annual report released by the United States Renal Data System (USRDS) found the following highlights:

Children with Kidney Failure

Fewer children under five years old with kidney failure are dying. Mortality one year after kidney failure has dropped by nearly half over the past decade.

Kidney Transplant Waiting List

For the first time ever, the number of people waiting for a kidney decreased. This may be related to a recent change in federal policy on kidney transplantation.

Mortality

Dialysis patient mortality decreased by nearly one-third from 2001 – 2015, but mortality rates have stabilized in recent years.

Chronic Kidney Disease (CKD)

1 in 7 Americans has chronic kidney disease, but most of them are not aware of their disease.

Acute Kidney Injury

Only 1 out of every 7 Medicare patients hospitalized for acute kidney injury saw a kidney doctor after discharge. More than 1 in 3 were re-hospitalized.

Kidney Failure

The United States has the third highest rate of new cases of kidney failure in the world. The rate of new cases in 2015 was similar to recent years.

Vascular Access

4 out of 5 new dialysis patients start was a catheter, which can lead to preventable infections. Fewer than 1 in 5 starts with the preferred access type: an arteriovenous fistula.

Cost to Medicare

In 2015, 1 out of every 5 Medicare dollars was for patients with CKD. Medicare spend $98 billion for people with chronic kidney disease, including $34 billion for people on dialysis.

Additional important findings:

The one-year end-stage renal disease patient mortality among the 0-4-year age group has declined approximately 41.6 percent over the past decade. This is good news.

The kidney allocation system policy changes resulted in a first time decrease in kidney transplant waiting list by 2.3 percent. While too soon to predict longer term benefits, the new policy may assist minorities and low-income persons, who often take longer to get waitlisted.

Incidence rates of end-stage renal disease have stabilized in the U.S., however there are large variations around the country with many hotspots.

Eighty percent of patients still use catheters as the main vascular access at initiation of hemodialysis. This must change, as catheters predispose to serious infections and higher mortality.

Seventeen percent of patients used an arteriovenous fistula exclusively at dialysis initiation. This increased to 65 percent by the end of one year on hemodialysis, and to 72 percent at the end of two years.

Between 2001 and 2015, adjusted mortality rates decreased by 28 percent for dialysis patients. The net reductions in mortality from 2001 to 2015 were 27 percent for hemodialysis patients and 41 percent for peritoneal dialysis patients. However, since there appears to be a stabilization in mortality rates in recent years, there is no room for complacency.

In 2013, Medicare patients aged 66 years and older who were hospitalized for an acute kidney injury (AKI) had a 35 percent cumulative probability of a recurrent AKI hospitalization within one year.